Milk Discharge with Normal Prolactin Levels: What to Do?

Normal prolactin levels but milk secretion?

Hello Doctor,
I have never given birth or been pregnant, but in mid-July, I noticed a milky white discharge resembling the color of rice washing water when I squeezed my breast.
A breast surgeon performed an ultrasound and confirmed that there were no issues with my breast.
They also tested my prolactin levels, which were 48, slightly elevated.
On the same day, I had an appointment with an obstetrician-gynecologist, and I asked about the prolactin levels.
He mentioned that prolactin levels can fluctuate and advised me not to stimulate or squeeze my breasts.
After a week, I had my blood drawn again to check my prolactin levels, which had dropped to 9, within the normal range.
Although the levels are now normal, I still notice some discharge resembling milk when I squeeze my breasts (there is no discharge if I do not squeeze).

I would like to ask Dr.
Tsao if this situation can be ignored.
I am unsure if I need to undergo any further tests.
Thank you for your clarification.

P.S.
My menstrual cycle, TSH, and free T4 levels are all normal.

Pinggu, 30~39 year old female. Ask Date: 2017/09/14

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, if the surgical examination is normal and there are no discomforts, observation is sufficient.
Wishing you good health.

Reply Date: 2017/09/14

More Info

When it comes to the discharge of milk-like fluid from the breasts in individuals who have not been pregnant or given birth, it can be concerning and confusing. In your case, you experienced a discharge that was initially accompanied by elevated prolactin levels, which subsequently returned to normal after a week. This situation raises several important points regarding breast discharge, prolactin levels, and what steps to take next.

Prolactin is a hormone produced by the pituitary gland that plays a crucial role in lactation. Elevated prolactin levels can lead to galactorrhea, which is the production of breast milk in individuals who are not breastfeeding. Various factors can cause elevated prolactin levels, including stress, certain medications, and underlying health conditions such as hypothyroidism or pituitary disorders. In your case, the initial high level of 48 ng/mL was concerning, but the follow-up test showing a decrease to 9 ng/mL indicates that your prolactin levels have normalized.

The advice given by your healthcare providers to avoid stimulating the breasts is sound. Physical stimulation can lead to the release of prolactin, which may perpetuate the cycle of discharge. It is also important to note that the presence of a discharge does not always indicate a serious underlying condition, especially if imaging studies like ultrasound show no abnormalities.

Given that your menstrual cycle, TSH (Thyroid Stimulating Hormone), and free T4 levels are normal, this further supports the idea that there may not be a significant underlying endocrine issue. However, if the discharge continues or if you experience any other symptoms such as breast pain, changes in breast tissue, or irregular menstrual cycles, it would be prudent to follow up with your healthcare provider.

In terms of further evaluation, if the discharge persists despite normal prolactin levels, you might consider discussing the following options with your doctor:
1. Repeat Prolactin Testing: While your levels are currently normal, it may be beneficial to monitor them over time to ensure they remain stable.

2. MRI of the Pituitary Gland: If there are concerns about a prolactinoma (a benign tumor of the pituitary gland that produces excess prolactin), an MRI can help visualize the pituitary gland and rule out any abnormalities.

3. Endocrine Evaluation: A comprehensive evaluation by an endocrinologist may provide additional insights, especially if there are concerns about other hormonal imbalances.

4. Medication Review: If you are taking any medications, review them with your doctor to see if they could be contributing to elevated prolactin levels.

5. Lifestyle Factors: Stress management techniques and lifestyle modifications can also be beneficial, as stress can impact hormone levels.

In summary, while the normalization of your prolactin levels is reassuring, the continued discharge warrants monitoring. It is essential to maintain open communication with your healthcare provider and report any changes or new symptoms. Regular follow-ups will help ensure that any potential issues are addressed promptly and effectively.

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